Chinese Journal of Plastic and Reconstructive Surgery最新文献

Background

The nasal alar defect in Asians remains a challenging issue, as do clear classification and algorithm guidance, despite numerous previously described surgical techniques. The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients.

Methods

A retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022. Based on careful analysis and our clinical experience, we proposed a classification system for nasal alar defects and presented a reconstructive algorithm. Patient data, including age, sex, diagnosis, surgical options, and complications, were assessed. The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale.

Results

Among the 32 patients, there were 20 males and 12 females with nasal alar defects. The predominant cause of trauma in China was industrial factors. The majority of alar defects were classified as type I C (n=8, 25%), comprising 18 cases (56.2%); there were 5 cases (15.6%) of type II defect, 7 (21.9%) of type III defect, and 2 (6.3%) of type IV defect. The most common surgical option was auricular composite graft (n=8, 25%), followed by bilobed flap (n=6, 18.8%), free auricular composite flap (n=4, 12.5%), and primary closure (n=3, 9.4%). Satisfactory improvements were observed postoperatively.

Conclusion

Factors contributing to classifications were analyzed and defined, providing a framework for the proposed classification system. The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians.

Background

The stromal vascular fraction (SVF), a cluster of stem and progenitor cells isolated from adipose tissue, holds significant promise for application in regenerative medicine. However, the existing methods for SVF isolation are time-consuming and expensive. Thus, in this study, we explored a new method of SVF extraction—ultrasound-assisted SVF isolation (USASI)—and compared the viability and characteristics of SVF isolated using different methods.

Methods

SVF extraction methods using different combinations of ultrasound power, ultrasound time, collagenase dosage, and collagenase digestion time were compared with those of the control group (collagenase digestion method). The cell yield and vitality of the SVF were evaluated via cell counting and trypan blue staining. The cell components and immunophenotypes of freshly isolated SVF were analyzed using flow cytometry. The proliferative capacity and differentiation potential of the SVF were also identified.

Results

Ultrasonication at 95 ​W-20 kHz for 30 ​s followed by digestion with 0.15% collagenase for 30 ​min was identified as the most suitable parameter for the USASI method in isolating SVF, as recommended based on the evaluation of various tested conditions. The USASI method significantly reduced the collagenase dosage and shortened the digestion time. Compared to the collagenase digestion method, the USASI method had a higher cell yield and cell viability, with no adverse effects on cell components, proliferative capacity, or multipotential differentiation capacity.

Conclusion

With reduced processing time, lower collagenase dosage, and increased cell yield without impairing the viability and characteristics of SVF, USASI holds the potential to emerge as a time-saving and cost-effective method for future clinical applications.

Epicanthus is a half-moon-shaped skin fold diagonally or vertically distributed in front of the medial canthus. In mild cases, it affects aesthetics, whereas in severe cases, it may obscure the patient’s field of vision and even affect the functional development of the eyes in children. Until now, surgery has been the only corrective measure for epicanthus and a bewildering number of epicanthus-related surgical procedures have been reported; however, there is no standardized classification to guide inexperienced plastic surgeons in their study or case selection. Therefore, this review aimed to classify epicanthus accordingly and introduce its corresponding and appropriate surgical treatment modalities.

Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict. In this scenario, most amputees develop residual and phantom limb pain, impacting their quality of life. There are several elective surgical procedures available for both conditions, such as neuroma excision followed by nerve reconstruction, nerve relocation, e.g., surgically implanting a transected nerve into a muscle, nerve transfers in cases of associated paralysis, and most recently, regenerative peripheral nerve interface surgery. Whenever possible in the post-conflict phase, a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees. While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article, we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide: the high-quality care and treatment of refugees and those whose lives have been impacted by conflict, disaster, or displacement.

Background

Several reconstructive techniques have been used to reconstruct scalp defects. Numerous researchers have studied the utilization of bipedicled scalp advancement flaps for scalp defect coverage. In this study, we will assess the adaptability of a bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection.

Methods

This study was performed at the Plastic Surgery Department, Fayoum University Hospital, on 20 patients with huge scalp tumors treated by adequate excision and reconstructed using a bipedicled scalp advancement flap from December 2021 to July 2023.

Results

The study was conducted on 20 patients: 16 (80%) were men and 4 (20%) were women presenting with large scalp tumors. The mean age was 57.4 years (33–68 years). The sites of the tumors were 10 (50%) occipital, 6 (30%) parietal, and 4 (20%) parieto-occipital. No major complications occurred postoperatively, and the bipedicled flaps survived well in all cases, with no necrosis.

Conclusion

Huge scalp defects after tumor resection can be safely reconstructed with a large versatile bipedicled advancement scalp flap, either transversely or longitudinally oriented, with favorable functional results and accepted aesthetic results, apart from the alopecic area over the grafted donor site, which can be treated by tissue expansion if desired later.

In this report, we present the case of a 55-year-old woman with a 30-year history of multiple familial trichoepithelioma (MFT), with facial surface tumors that progressively worsened, causing ventilation disorders. In order to improve the patient’s appearance and functional impairment, we performed a two-step surgical excision and skin grafting procedure post diagnosis through genetic testing. The 18-month follow-up confirmed that the effect was satisfactory without obvious recurrence. Based on this outcome, we have developed a diagnosis and treatment process for patients with MFT, aiming to provide a reference for standardized treatment of this rare disease.

Background

Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment. Vascularized lymph node transfer (VLNT) is a promising approach to reduce lymphedema. This study used magnetic resonance lymphangiography (MRL) to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema (BCRL).

Methods

The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT (4 cases) or VLNT combined with breast reconstruction (2 cases) were retrospectively reviewed. All patients were examined using MRL preoperatively and at the 1-year follow-up. The morphological characteristics of the lymphatic network, dermal backflow patterns, and architecture of the lymph nodes were evaluated. Clinical outcomes, patient satisfaction, and complications were assessed.

Results

At the 1-year follow-up, reduction in tissue edema and limb circumference was achieved in all six patients. In MRL, the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients. Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients. Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients. No disruption of the lymph flow in the donor area was detected.

Conclusion

This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL. Overall, our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.

Background

Nasal defects due to rat bites are frequently encountered in rural regions of China. In addition to serving as disease vectors, rats can also inflict bite injuries. In this study, we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period.

Methods

We retrospectively reviewed hospital records for patients admitted due to rat bites. This study outlines the demographics, clinical features, and follow-up outcomes supported by comprehensive photo documentation of the patients’ progress.

Results

Twenty-five patients, with a mean age of 29 years, were admitted due to rat bites. Treatment was provided for three distinct types of injuries: nasal tip defect (type I), nasal defect (type II), and full-thickness nasal defect with loss of surrounding tissues (type III). All patients recovered fully.

Conclusions

The treatment for rat bites should be based on the wound type. The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected. We recommend early surgical intervention, along with psychological therapy, to prevent interference with growth and development.

Background

Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction. However, surgeons worldwide have not agreed on the details of graft harvesting, including rib selection, side preference, operation mode, cutting methods, and handling of the periosteum and perichondrium. This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5 years and identify potential avenues for future research.

Methods

We searched for related articles in PubMed, Embase, and Web of Science from 2019 to 2023, summarized crucial but controversial steps in recent practice, and analyzed their theoretical basis and clinical feasibility.

Results

Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction, with the 5th to 8th ribs and cartilage being the most used. The laparoscopic harvest is gaining attention, being second only to the open harvest, with the 9th/10th ribs and cartilages being particularly convenient. The clinical applications of full-cut and split-cut methods differ in their advantages. Except for some special reasons, almost all studies tended to preserve the periosteum and perichondrium in situ, and few surgeons chose to harvest the grafts on the left side.

Conclusion

Multiple techniques have emerged, requiring surgeons to balance the benefits and risks of various strategies at each step. New theories and techniques should be fully tested promptly and in clinical practice before wide application. Overall, a professional consensus is needed for better directivity, precision, and stability in clinical practice.